Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
BMC Cardiovasc Disord. 2022 Mar 31;22(1):136. doi: 10.1186/s12872-022-02552-6.
This study evaluates cardiac diseases and prognosis in young adults and adults presenting with ventricular tachyarrhythmias (VTA).
The present longitudinal, observational, registry-based, monocentric cohort study includes all consecutive patients 45 years old or younger presenting with VTA at admission from 2002 to 2016. Rates of coronary angiography, coronary artery disease (CAD) and need for percutaneous coronary intervention (PCI), cardiac diseases associated with VTA, and differences in long-term prognostic endpoints for young adults (20-34 years old) were analyzed and compared to those of adults (35-45 years old), for whom multivariable risk prediction models were developed. Kaplan-Meier analyses were performed according to age and type of VTA.
A total of 259 consecutive patients were included in the study (36% young adults and 64% adults). At admission, 38% of young adults had VTA due to CAD that required PCI. Furthermore, VTA in young adults was commonly idiopathic (27%), or had underlying channelopathies (18%), primary cardiomyopathies (13%) or acute myocardial infarction (AMI, 11%). In adults, VTA was mostly associated with AMI (28%), though the rate of idiopathy was still high (20%). A total 41% of all patients received cardiopulmonary resuscitation (CPR), for whom AMI (STEMI 17%, NSTEMI 24%) was most frequently observed. Irrespective of the type of VTA, all-cause mortality was similar for young adults and adults. In young adults, left ventricular ejection fraction (LVEF) < 35% (HR = 33.590) was associated with increased long-term all-cause mortality.
Despite high rates of idiopathic ventricular tachyarrhythmias, CAD and AMI are common causes of VTA and CPR in adults 45 years old and younger. Young adults and adults had comparable survival at index hospitalization and after 2.5 years irrespective of the type of VTA. Clinical trial registration clinicaltrials.gov identifier: NCT02982473.
本研究评估了患有室性心动过速（VTA）的年轻成年人和成年人的心脏疾病和预后。
本项纵向、观察性、基于登记的单中心队列研究纳入了 2002 年至 2016 年期间因 VTA 入院的所有年龄在 45 岁或以下的连续患者。分析了冠状动脉造影、冠状动脉疾病（CAD）和经皮冠状动脉介入治疗（PCI）的需求、与 VTA 相关的心脏疾病以及年轻成年人（20-34 岁）和成年人（35-45 岁）之间的长期预后终点差异，并为后者建立了多变量风险预测模型。根据年龄和 VTA 类型进行 Kaplan-Meier 分析。
共纳入 259 例连续患者（36%为年轻成年人，64%为成年人）。入院时，38%的年轻成年人因需要 PCI 的 CAD 而患有 VTA。此外，年轻成年人的 VTA 通常为特发性（27%），或伴有通道病（18%）、原发性心肌病（13%）或急性心肌梗死（AMI，11%）。在成年人中，VTA 主要与 AMI（28%）相关，但特发性疾病的比例仍然很高（20%）。所有患者中有 41%接受了心肺复苏（CPR），其中 AMI（ST 段抬高型心肌梗死 17%，非 ST 段抬高型心肌梗死 24%）最为常见。无论 VTA 类型如何，年轻成年人和成年人的全因死亡率相似。在年轻成年人中，左心室射血分数（LVEF）<35%（HR=33.590）与长期全因死亡率增加相关。
尽管特发性室性心动过速的发生率较高，但 CAD 和 AMI 是 45 岁及以下成年人 VTA 和 CPR 的常见原因。年轻成年人和成年人在指数住院期间和 2.5 年后的存活率相似，无论 VTA 类型如何。临床试验注册临床Trials.gov 标识符：NCT02982473。
